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Updated: Nov 4, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Mechanical Thrombectomy Improves Outcome for Large Vessel Occlusion Stroke after Cardiac Surgery
D Andrew Wilkinson1, Sravanthi Koduri1, Sharath Kumar Anand1
1Departments of Neurosurgery, University of Michigan, Ann Arbor, Michigan.
Insights
Large vessel occlusion (LVO) stroke after cardiac surgery is rare but serious. Thrombectomy significantly improves outcomes for these patients, highlighting the need for awareness and optimized care.
Area of Science:
- Neurology
- Cardiology
- Interventional Radiology
Background:
- Stroke is a significant concern following cardiac surgery.
- Large vessel occlusion (LVO) strokes can be effectively treated with modern clot-retrieval techniques.
Purpose of the Study:
- To determine the incidence of LVO stroke post-cardiac surgery.
- To describe the clinical outcomes of patients experiencing LVO stroke after cardiac surgery.
Main Methods:
- Retrospective review of patients undergoing cardiac surgery between 2014-2018.
- Identification and analysis of LVO strokes using imaging and medical records.
Main Results:
- The incidence of acute ischemic stroke was 2.3%, with LVO stroke occurring in 9.2% of stroke cases (0.2% overall).
- Patients undergoing mechanical thrombectomy for LVO stroke showed significantly better outcomes (66.6% independent living) compared to medical management (0%).
- A notable proportion of patients not receiving thrombectomy may be candidates under expanded treatment criteria.
Conclusions:
- The rate of LVO stroke after cardiac surgery is low but elevated compared to the general population.
- Mechanical thrombectomy is associated with improved neurologic outcomes in LVO stroke patients post-cardiac surgery.
- Enhanced postoperative care and patient/caregiver education are crucial for recognizing LVO stroke and utilizing effective therapies like thrombectomy.
Background:
Stroke is a feared complication of cardiac surgery. Modern clot-retrieval techniques provide effective treatment for large vessel occlusion (LVO) strokes. The purpose of this study was to 1) report the incidence of LVO stroke after cardiac surgery at a large academic center, and 2) describe outcomes of postoperative LVO strokes.
Methods:
All patients experiencing stroke within 30 days after undergoing cardiac surgery at a single center in 2014-2018 were reviewed. LVOs were identified through review of imaging and medical records, and their characteristics and clinical courses were examined.
Results:
Over the study period, 7,112 cardiac surgeries, including endovascular procedures, were performed. Acute ischemic stroke within 30 days after surgery was noted in 163 patients (2.3%). Among those with a stroke, 51/163 (31.3%) had a CTA or MRA, and 15/163 (9.2%) presented with LVO stroke. For all stroke patients, the median time from surgery to stroke was 2 days (interquartile range, IQR, 0-6 days), and for patients with LVO, the median time from surgery to stroke was 4 days (IQR 0-6 days). The overall rate of postoperative LVO was 0.2% (95% CI 0.1-0.4%), though only 6/15 received thrombectomy. LVO patients receiving thrombectomy were significantly more likely to return to independent living compared to those managed medically (n = 4/6, 66.6% for mechanical thrombectomy vs. n = 0/9, 0% for medical management, P = .01). Of the 9 patients who did not get thrombectomy, 6 may currently be candidates for thrombectomy given new expanded treatment windows.
Conclusions:
The rate of LVO after cardiac surgery is low, though substantially elevated above the general population, and the majority do not receive thrombectomy currently. Patients receiving thrombectomy had improved neurologic outcomes compared to patients managed medically. Optimized postoperative care may increase the rate of LVO recognition, and cardiac surgery patients and their caregivers should be aware of this effective therapy.
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